目的：探讨心率变异性（ HRV）对冠心病以及冠心病合并心力衰竭患者评定价值以及其临床价值。方法将88例冠心病患者分为冠心病组（ B组）和冠心病合并心力衰竭组（ C组）两组。冠心病组为左室射血分数（ EF）≥50％的CAD患者30例，冠心病合并心力衰竭组为EF＜50％的患者58例；另选择健康对照者31例对照组（ A组），进行24 h动态心电图监测，获得HRV各项时域指标并进行分析。结果 A组和B组、B组和C组之间全部窦性心搏R-R间期的标准差（ SDNN）、全程记录中每5分钟R-R间期平均值的标准差（SDANN）、全程记录中每5分钟R-R间期标准差的平均值（SDNNI）均差异有统计学意义（P＜0．05），A组和C组之间SDNN、ANN、SDNNI差异有统计学意义（P＜0．01），A组和C组之间全程相邻R-R间期差值的均方根（rMSSD）、全部相邻的R-R间期之差大于50 ms的心搏数占总心搏数的百分比（PNN50）差异有统计学意义（P＜0．05），A组和B组之间rMSSD 、PNN50差异无统计学意义（P＞0．05）。 B 组和C组之间rMSSD， PNN50差异无统计学意义（ P＞0．05）。同时随心功能的下降， SDNN和SDANN降低，但差异无统计学意义（均为P＞0．05），而SDNNI 、RMSSD和PNN50随着心功能的下降而显著下降同时在与心功能I级比较时差异有统计学意义（ P＜0．05）。结论冠心病尤其是伴发心力衰竭患者，HRV降低较为明显。%Objective To investigate the evaluation and clinical value of Heart rate variability (HRV) for coronary atherosclerotic disease ( CAD) combined with heart failure .Methods Eighty-eight patients with CAD were included and divided into group C (n=58,EF<50%) and group B (n=30,EF≥50%).Thirty-one normal subjects were chosen as control group A .Each patient underwent 24h ECG monitoring and various indexes of time domain in HRV were collected and analyzed .Results There were significant differences in SDNN ,SDANN and SDNNI ( P<0.05) between group A and group B ,also between group B and group C ,group C were different from the control group in SDNN,SDANN,SDNNI (P<0.01) and rMSSD,PNN50(P<0.05).There were not significantly differences in rMSSD,PNN50 (P>0.05) between group A and group B,also between group B and group C.And with the decre ment of heart function,SDNN,SDANN also dropped,but no statistic differrnce(P>0.05),Conclusion HRV is obviously de-creased in patients with CAD,especially in those who are combined with decrement of left ventricular systolic function .
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